=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477787497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENISSEJOVE MATOS GYNECOLOGY GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2009
-----------------------------------------------------
Last Update Date | 05/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 CALLE ANTONIO R BARC SUITE 3
-----------------------------------------------------
City | ARECIBO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00612-4724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-878-0861
-----------------------------------------------------
Fax | 787-879-0148
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 946
-----------------------------------------------------
City | ARECIBO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00613-0946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-878-0861
-----------------------------------------------------
Fax | 787-879-0148
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D.
-----------------------------------------------------
Name | DR. DENISSE JOVE MATOS
-----------------------------------------------------
Credential | 13587
-----------------------------------------------------
Telephone | 17878780861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------